Bulimia Nervosa


Step 1: View clinicals

A 22 year old woman is brought in by her boyfriend, who noticed her self-inducing vomiting after a meal. Questioning reveals that she consumes rather small meals, skips meals entirely at times, and engages in binge-eating behavior around twice a week, which she regrets later on. She also obsessively exercises, spending hours at the gym, and avoids going out with her friends or going to parties, stating that she wishes to avoid 'unhealthy' eating as she fears becoming obese. These symptoms date from 9 years ago, at which time she was overweight, and dissatisfied with her body image. Over the following few months, she lost about 12 kg and became normal in weight, but continued with the above behavior, as she felt that she was not 'thin' enough. Her medical history is unremarkable, and her menstrual cycles are regular, occurring at 28 day intervals. Her family history is only positive for depressive disorder in the paternal grandmother. She only drinks socially, and does not smoke or use recreational drugs.

Step 2: Order all relevant investigations

Full Blood Count

WBC: 6,200/mm3 (4,000-11,000) Hb: 12.3 g/dL (11-18) Platelets: 200,000/mm3 (150,000-400,000)

Thyroid Profile

TSH: 1.8 mIU/L (0.4 - 4.0) Free T3: 151 ng/dL (100 - 200) Free T4: 6.2 mcg/dL (4.5 - 11.2)

Metabolic Profile

Serum Na+, K+, Cl-, Mg++: within normal parameters Blood Urea & Serum Creatinine: within normal parameters Liver Profile: no abnormalities noted

Beck Depression Inventory

Beck Depression Inventory (BDI) score: 6/63 (not depressed):

Step 3: Select appropriate management

Cognitive Behavioral Therapy

Score: ★★☆